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TRANSACTTON REQUEST FOR
PURCHASE I SWITCH / REDEMPTION
(Please use separate transaction slip for each scheme,
BHAROSA APNO KA For upating your contact details, please submit a separate request)

21120125t25 HDFC lndex Fund-NIFTY 50 PIan - DIRECT(G)

Folio Number Scheme/PIan/Option*
(Switch-out scheme
Name of Sole/ SIEMENS INFORMATION SYSTEMS LIMITED EMPL( for switch request)
First Unit Holder

KEY PARTNER
Internal Code for Employee Unique
ARN/RIA Code ARNiRIA Name Sub Agent's ARN Bank Branch Code
Slrh-AoFnt/ Fmnlovae [Link]^n N,,mh6. /Fl lTNl\

AfiN - 1NA200014140 AIIN "

ImDortant: Please strike off anv unused Dortion ofthis sheet.

EI lOOfffOmAL PURCHASE (Please write your folio number and name on the reverse of the cheque/DD/Payment Instrument no.)
PaymentMode:(Pleasetickanyoneonly) EOTM (OneTimeBankl4andate) [Cfreque EOO EFundsTransfer ERTCS/tlfff
Cheque/DD/Instrument No: !.,?'ita.:i:.,i:;-:;- :.1' Payment Date/Instrument Date | _ l_ t_ Amount (Rs.) : 7250000
Bank Name: HDFC BANK LIMITED s6666; H T HOUSE - DELHI City : NEW DELHI
MANDATORY FOR OTM

NSDL CDSL
DP Name HDFC BANK LIMITED
DP iD rTT-3--0--o-z-zTl
Beneficiary Account No. t7--0--0--6--6--6- l
Please attach a copy ofthe DP statement / Client Master Form to enable usto verii/ the demat account details.

succe$ful verification with thedeDGitorvrecordsand realization of

I SwffCn REQUEST (prease tick any one onryl I All Free Units I No. of units : I Amount (in Rs.) :

To Scheme / Plan / Option" :

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Redeem ! Al Free units E No. of Units f] Anrount (in Rs.) (in words)
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J IFSC Code (if not provided earlier for electronic paymeni)
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o the requestfor changingthe bank account details will not be processed.
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F for Multiole Bank Accounts faciliw" in the above folio:
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c The redemption should be processed into the following bank account as per the payout mechanism [Link] by melus 0hb bank account hasalrffidy been registerd in the fli0):
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Name of the Bank
fi tr! : Branch :

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Accounl No. : Account Type : Bank Cily :

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or
you to send the entire such (lessr) balance to me/us.

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Elu compliance with applicable hdian and foreign law. I/We hereby confirm and declare as under:-
or the l@d skucture.
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may be required and fufther undertake that In Ve shall b€ liable, in the event the details and/or any part thersf is found to be false/unb-ue/misleading.
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India (FIU-IN D) etc. widrout any inumation/advice to me/us,
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5) I,lWewillindemnirytheFund,Al4C,TruSee,RTAandotherintermediariesin@*[Link],wlidityandaulhoriationofmy/@[Link].

c which the Scheme is being reommended to me/us.

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F (including taxation) arising out ofthe failure to redeem on account of change in residential status.
Applicable to NRIs/PIO/OCIS only: I/lI/e confirm that my application is in compliance with applicable Indian and foreign laws.
Please (.,/) f]Ves [t'to If Yes, (v/) ERepatriation basis fiNon-repatriation basis N
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I/Llre hereby confirm that the EUIN box has been intr by me,lus as this transaction is executed without any iilteraction or advice by the employee/relationship o
manager/sals pe6on ofthe above distributor/sub br Itrg the advice of in-appropriateness, if any, provided bVthe employee/relationship manager/sales person a
of the distributor/sub broker. U
T0 BE [Link] BY ALL UNIT HOLDEFS IF lvlODE OF H0LDING [Link] ALTERATIONS, lF ANY SHOULD BE COUNTERSIGNED o
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Second unit holder
^ Third Ljnit holder

(To be filled and signed by folio(s) with Single holders only. In case offolio(s) with Joint holders / Entities, separate SUPPLEI\4ENTARY
KNOWYOURCUENT (KYC), FATCA &CRS - SELF CERTIFICATION FOR[4 needsto besubmitted)

PAN

Is the applicant/guardian's Country of Birth/CitizenshiplNationalityffax Residency other than India? E yes E No

tf yes, then please submit a Supplementary Know Your Client (l(Yc), FATCA and CRS - Self certification form attached alonq-with this transaction.
D€claration: I have read and understood the information requirements and the Terms and Conditions mentioned in the SUPPLE[4ENTARY KNOW
YOUR CLIENT (KYC), FATCA & CRS - SELF CERTIFICATION FOR[,] and hereby confirm that the information provided by me/us on this Form is true,
correct and complete. I hereby agree and confirm to inform HDFC Asset Manaqement Company Limited/HDFC Mulual Fund/ Trustees for any
modification to this informatioir piomptly. t further agree to abide by the proviiions of the icherne relatbd documents inter'alia provisions on
'Foreign AccountTax Compliance Act (FATCA) and Common Reporting Standards (CRS) on Automatic Exchange oflnformation (AEOI)'. I hereby
authorize [Link] disclose, share, remit in any form/manner/mode the above informatioh and/or any part of it including the chan0es/updates that
may be provided by me to the Murual Fund, its Sponsor/s, Trustees, Asset l4anagement Company, its employees, agents and third paty seruice
providers, SEBI registered intermediaries for single updation/ submission, any Indian or foreign statutory regulatory iudicial, quasi- ludicial
authorities/agencies including but not limited to Financial Intelligence Unit-India (FIU-IND) etc without any intimation/advic-e to me. Sign of Sole Holder